N1b 期甲状腺乳头状癌患者发生 V 区转移的危险因素。

Risk factors for level V metastasis in patients with N1b papillary thyroid cancer.

机构信息

Department of Surgery, Yeungnam University College of Medicine, 170 Hyunchoong-ro, Namgu, Daegu, 42415, South Korea.

出版信息

World J Surg Oncol. 2022 Sep 30;20(1):327. doi: 10.1186/s12957-022-02782-0.

DOI:10.1186/s12957-022-02782-0

PMID:36180912

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9524026/

Abstract

BACKGROUND

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and its incidence has increased. Lateral lymph node metastasis (LLNM) implies a worse prognosis than central lymph node metastasis, with a higher recurrence rate and decreased disease-free survival. The 2015 American Thyroid Association guidelines recommend compartmental node dissection in patients with LLNM to reduce the risk of recurrence and mortality. The purpose of this study was to identify the risk factors for level V lymph node (LN) metastasis in patients with N1b papillary thyroid cancer (PTC).

METHODS

A total of 110 consecutive patients who underwent total thyroidectomy with lateral neck dissection for PTC between April 2016 and April 2022 were retrospectively enrolled. Based on level V metastasis, 94 patients were divided into two groups, and their clinicopathological characteristics were compared. Univariable analysis were used to assess the factors associated with level V metastasis. Spearman correlation analysis were used to assess the correlation between tumors and LN. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value for the number of metastatic LNs at each level for level V metastasis.

RESULTS

The number of metastatic LNs and lymph node ratio (LNR) in level II were significantly associated with level V metastasis (P = 0.011 and 0.001, respectively). The number of metastatic LNs in level II and those in the total number of levels correlated with the number of metastatic LNs in level V (rho = 0.331, 0.325, and P = 0.001, 0.001, respectively). The cutoff value for the number of metastatic LNs in level II was defined as 2.5 (area under the curve = 0.757, sensitivity = 50%, specificity = 82.5%, 95% confidence interval [CI] 0.626-0.889, P = 0.002). Simultaneous 3-level metastasis (level II, III, and IV) and 3-level with ≥ 2.5 metastatic LNs in level II were significantly associated with level V metastasis (P = 0.003 and 0.002).

CONCLUSIONS

The number of metastatic LNs and LNR in level II, simultaneous 3-level metastasis (level II, III, and IV), and 3-level with ≥ 2.5 metastatic LNs in level II were significantly associated with level V metastasis. (P = 0.011, 0.001, 0.003, and 0.002, respectively). In the future, larger-scale multi-institutional studies were needed to find out predictors for level V metastasis.

摘要

背景

甲状腺乳头状癌（PTC）是最常见的甲状腺癌类型，其发病率有所增加。侧颈淋巴结转移（LLNM）比中央颈淋巴结转移预示着更差的预后，复发率更高，无病生存率降低。2015 年美国甲状腺协会指南建议对有 LLNM 的患者进行分区淋巴结清扫，以降低复发和死亡风险。本研究旨在确定 N1b 期甲状腺乳头状癌（PTC）患者发生 V 区淋巴结（LN）转移的危险因素。

方法

回顾性分析 2016 年 4 月至 2022 年 4 月期间 110 例因 PTC 行甲状腺全切除术和侧颈部淋巴结清扫术的连续患者的临床病理资料。根据 V 区转移情况，94 例患者分为两组，比较其临床病理特征。单变量分析用于评估与 V 区转移相关的因素。Spearman 相关分析用于评估肿瘤与 LN 之间的相关性。受试者工作特征（ROC）曲线用于确定各水平转移性 LN 数量的最佳截断值，以预测 V 区转移。

结果

II 区转移的 LN 数量和淋巴结比值（LNR）与 V 区转移显著相关（P=0.011 和 0.001）。II 区转移的 LN 数量与总转移的 LN 数量与 V 区转移的 LN 数量呈正相关（rho=0.331、0.325，P=0.001、0.001）。II 区转移的 LN 数量的截断值定义为 2.5（曲线下面积=0.757，灵敏度=50%，特异性=82.5%，95%置信区间[CI]0.626-0.889，P=0.002）。同时 3 个水平（II、III 和 IV 区）转移和 3 个水平伴有 II 区≥2.5 个转移的 LN 与 V 区转移显著相关（P=0.003 和 0.002）。